中国卒中杂志
中國卒中雜誌
중국졸중잡지
CHINESE JOURNAL OF STROKE
2014年
12期
1007-1013
,共7页
傅小玲%石玉芝%高畅%楚勤英%李建华%舒刚明
傅小玲%石玉芝%高暢%楚勤英%李建華%舒剛明
부소령%석옥지%고창%초근영%리건화%서강명
谵妄%卒中%奥氮平%直肠给药
譫妄%卒中%奧氮平%直腸給藥
섬망%졸중%오담평%직장급약
Delirium%Stroke%Olanzapine%Rectal administration
目的探讨奥氮平直肠给药对老年缺血性卒中后患者谵妄的治疗效果及安全性。<br> 方法采用前瞻性研究的方法，将解放军总医院第一附属医院干二科2013年3月1日～2014年2月18日收治的60例缺血性卒中后谵妄的住院患者分为口服给药组及直肠给药组。两组患者均在谵妄发生后24 h内给予奥氮平治疗。用药前及用药1周后对两组均进行谵妄评定量表（Confusion Assessment Method， CAM）及美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分分别评估两组患者用药前及用药后的谵妄严重情况及卒中严重程度。比较两组患者用药治疗1周后的用药平均剂量、治疗效果及副作用等。3个月后对两组患者进行改良Rankin量表（modified Rankin Scale，mRS）评分随访以评估药物治疗是否影响缺血性卒中患者的预后。<br> 结果①口服给药和直肠给药两组患者年龄、性别、1周内NIHSS及CAM得分差异均无显著性：NIHSS中位数（8.5 vs 10；P=0.79）、CAM[（25.8±3.1）vs（26.1±5.3）；P=0.79]；两组患者合并高血压病、糖尿病、冠状动脉粥样硬化性心脏病比例差异无显著性：高血压病（6.7% vs2.0%；P=0.18）、糖尿病（10.0% vs 23.3%；P=0.17）、冠状动脉粥样硬化性心脏病（50.0% vs 60.0%；P=0.43）；两组患者缺血性卒中部位比较差异无显著性（P=0.76）。②口服给药和直肠给药两组均未发生明显副作用。直肠给药组1周内平均给药剂量明显低于口服给药组[（5.33±2.12）vs（4.25±2.06）；P=0.03]。③用药1周后，直肠给药组CAM、NIHSS评分均明显低于口服给药组：CAM[（19.8±3.9）vs（15.2±2.1）；P=0.00]、NIHSS中位数（7.5 vs 6.5；P=0.00）。3个月后随访mRS得分提示两组之间差异无显著性（P=0.15）。<br> 结论老年缺血性卒中后谵妄患者，尤其是口服给药困难者，直肠给药可能是一种较安全有效的替代方式，但用药剂量尽量小于口服给药剂量。
目的探討奧氮平直腸給藥對老年缺血性卒中後患者譫妄的治療效果及安全性。<br> 方法採用前瞻性研究的方法，將解放軍總醫院第一附屬醫院榦二科2013年3月1日～2014年2月18日收治的60例缺血性卒中後譫妄的住院患者分為口服給藥組及直腸給藥組。兩組患者均在譫妄髮生後24 h內給予奧氮平治療。用藥前及用藥1週後對兩組均進行譫妄評定量錶（Confusion Assessment Method， CAM）及美國國立衛生研究院卒中量錶（National Institutes of Health Stroke Scale，NIHSS）評分分彆評估兩組患者用藥前及用藥後的譫妄嚴重情況及卒中嚴重程度。比較兩組患者用藥治療1週後的用藥平均劑量、治療效果及副作用等。3箇月後對兩組患者進行改良Rankin量錶（modified Rankin Scale，mRS）評分隨訪以評估藥物治療是否影響缺血性卒中患者的預後。<br> 結果①口服給藥和直腸給藥兩組患者年齡、性彆、1週內NIHSS及CAM得分差異均無顯著性：NIHSS中位數（8.5 vs 10；P=0.79）、CAM[（25.8±3.1）vs（26.1±5.3）；P=0.79]；兩組患者閤併高血壓病、糖尿病、冠狀動脈粥樣硬化性心髒病比例差異無顯著性：高血壓病（6.7% vs2.0%；P=0.18）、糖尿病（10.0% vs 23.3%；P=0.17）、冠狀動脈粥樣硬化性心髒病（50.0% vs 60.0%；P=0.43）；兩組患者缺血性卒中部位比較差異無顯著性（P=0.76）。②口服給藥和直腸給藥兩組均未髮生明顯副作用。直腸給藥組1週內平均給藥劑量明顯低于口服給藥組[（5.33±2.12）vs（4.25±2.06）；P=0.03]。③用藥1週後，直腸給藥組CAM、NIHSS評分均明顯低于口服給藥組：CAM[（19.8±3.9）vs（15.2±2.1）；P=0.00]、NIHSS中位數（7.5 vs 6.5；P=0.00）。3箇月後隨訪mRS得分提示兩組之間差異無顯著性（P=0.15）。<br> 結論老年缺血性卒中後譫妄患者，尤其是口服給藥睏難者，直腸給藥可能是一種較安全有效的替代方式，但用藥劑量儘量小于口服給藥劑量。
목적탐토오담평직장급약대노년결혈성졸중후환자섬망적치료효과급안전성。<br> 방법채용전첨성연구적방법，장해방군총의원제일부속의원간이과2013년3월1일～2014년2월18일수치적60례결혈성졸중후섬망적주원환자분위구복급약조급직장급약조。량조환자균재섬망발생후24 h내급여오담평치료。용약전급용약1주후대량조균진행섬망평정량표（Confusion Assessment Method， CAM）급미국국립위생연구원졸중량표（National Institutes of Health Stroke Scale，NIHSS）평분분별평고량조환자용약전급용약후적섬망엄중정황급졸중엄중정도。비교량조환자용약치료1주후적용약평균제량、치료효과급부작용등。3개월후대량조환자진행개량Rankin량표（modified Rankin Scale，mRS）평분수방이평고약물치료시부영향결혈성졸중환자적예후。<br> 결과①구복급약화직장급약량조환자년령、성별、1주내NIHSS급CAM득분차이균무현저성：NIHSS중위수（8.5 vs 10；P=0.79）、CAM[（25.8±3.1）vs（26.1±5.3）；P=0.79]；량조환자합병고혈압병、당뇨병、관상동맥죽양경화성심장병비례차이무현저성：고혈압병（6.7% vs2.0%；P=0.18）、당뇨병（10.0% vs 23.3%；P=0.17）、관상동맥죽양경화성심장병（50.0% vs 60.0%；P=0.43）；량조환자결혈성졸중부위비교차이무현저성（P=0.76）。②구복급약화직장급약량조균미발생명현부작용。직장급약조1주내평균급약제량명현저우구복급약조[（5.33±2.12）vs（4.25±2.06）；P=0.03]。③용약1주후，직장급약조CAM、NIHSS평분균명현저우구복급약조：CAM[（19.8±3.9）vs（15.2±2.1）；P=0.00]、NIHSS중위수（7.5 vs 6.5；P=0.00）。3개월후수방mRS득분제시량조지간차이무현저성（P=0.15）。<br> 결론노년결혈성졸중후섬망환자，우기시구복급약곤난자，직장급약가능시일충교안전유효적체대방식，단용약제량진량소우구복급약제량。
Objective To investigate the effectivity and safety about olanzapine administered rectally for ischemic stroke old patients. <br> Methods Sixty patients (aged≥65 years) admitted to the Department of Cardre Ward-2 of the First Afifliated Hospital of the General Hospital of People's Liberation Army (PLA) from March 2013 with delirium after a recent stroke was accepted. All these 60 patients were randomly divided into two groups to accept with olanzapine orally or rectally, respectively. All the patients fuliflled the National Institutes of Health Stroke Scale (NIHSS) and the Confusion Assessment Method (CAM) scale before and one week after they used the drug of olanzapine. Compare the baseline data, severity of the stroke and the delirium. One week after the patients used the drug, compare the mean dose of olanzapine, the treatment effect and the side effect of the two groups. We followed up all the 60 patients with modiifed Rankin Scale (mRS) after 3 months to evaluate the prognosis of the two methods of administration. Results ①There is no signiifcant difference between the oral group and the rectal group on the age, gender and the score of NIHSS and CAM: Media of NIHSS (8.5 vs 10;P=0.79)、CAM ([25.8±3.1] vs [26.1±5.3];P=0.79). Also the comorbidity of hypertension (6.7%vs 2.0%;P=0.18), diabetes (10.0%vs 23.3%;P=0.17) and coronary heart disease (CHD) (50.0%vs 60.0%;P=0.43) have no signiifcant differences between the two groups.②Both two groups' olanzapine orally and rectally are both well tolerated among these patients, and there is no signiifcant side effect on those 60 patients in the ifrst week ([5.33±2.12] vs [4.25±2.06];P=0.03).③The follow-up data after 3 months showed that there was no signiifcant difference between the two groups in the score of mRS (P=0.15). <br> Conclusion Olanzapine administered rectally may be an effective and safe method for delirium patients, especially for those patients who are dififculty in taking oral medicine. And the dose of rectal use should be less than that of oral use.
